On checking through the paper work, I noticed her husband had signed the consent form. I explained to him that this consent was not valid, and it would need two doctors' signatures. The husband, however, was under the impression that he had every right to do this, ad he was her power of attorney. I explained that this fact didn't matter, and that nobody other than a certified doctor could sign the consent of another adult. Subsequently, the surgeon was called in to rewrite and sign a new form. He, too, was under the impression that the husband could sign the form.
As all this was happening in front of the wife, I felt very embarrassed, as it looked as if no one knew what they were doing. All I knew was, I was right to ask for a new form. I would not have let the patient go to the theatre if the form had not been changed.
This situation not only deals with consent in general, but, more specifically, focuses on the reflective model of informed consent. Defined, "informed consent is a patient's right to be presented with sufficient information, by either the physician or their representative, to allow the patient to make an informed decision regarding whether or not to consent to a treatment or procedure" (Snyder, et. al.). Since the woman was incompetent, and could not make decisions for herself, she was required to have someone else consent on her behalf. However, she was not able to be informed herself.
The nurse thought she was correct in thinking the doctor was the only one in this situation who could sign the forms, which Kevin E Snyder, MD, Rebecca W West, JD, Wei-Shin Lai, MD and Spencer B Gay, MD confirm. "Informed consent must be obtained by a health care provider who is reasonably involved with the patient's care." However, it will appear later that she was actually misinformed in her class as to who could sign for an incompetent adult.
Informed consent is not a greatly complicated idea. "What the doctrine of informed consent means is that nurses must continually communicate with a patient, explaining procedures and obtaining the patient's permission," states Ginny Guido in Legal and Ethical Issues in Nursing. "If the patient is unable to communicate, permission may be derived from the patient's admission to the hospital or obtained from the patient's legal representative" (2001, 135).
Generally, there are six different aspects to the idea of informed consent:
"To be informed, patients must receive, in terms they can understand and comprehend, the following information:
A brief but complete explanation of the treatment or procedure to be performed.
The name and qualifications of the person to perform the procedure and, if others will assist, the names [and] qualifications of those assistants.
An explanation of any serious harm that may occur during the procedure, including death if that is a realistic outcome. Pain and discomforting side effects both during the procedure and following the procedure should also be discussed.
In explanation of alternate therapies to the procedure of treatment, including the risk of doing nothing